Post PLIF

I had PLIF surgery on May 17,2012. I was released from the hospital on May 20th. I felt like I was doing great for the first week and a half. On May 28th I started waking up at night with extreme leg pain. It's a very deep, aching, burning pain. It is always both legs but some nights is mostly behind my knees. I went for my first post op appointment. The x-ray showed every thing was in place and my staples were removed. The doctor stated that I was doing great and the incision was healing fine. He said the leg pain was probably due to the nerve(s) being manipulated during surgery and it should go away. I'm trying to be patient but I can't sleep for more than 2 1/2 hours at a time. I get a little relief by pacing around the house. I've tried icing, heating, stretching and having my husband massage my legs. It's started happening during the day yesterday. No relief! Now I'm concerned that my lack of sleep will impede the healing process. I'm calling the doctor's office this morning (Monday) to see if there is anything else I can do. Any suggestions from anyone would be greatly appreciated.

I would suggest you call your surgeon. If it is the nerves "waking up" or being irritated due to the surgery itself, it can take months for them to calm down, so your surgeon might want to put you on a "nerve pain" drug such as gabapentin or Lyrica.

I have had two lumbar fusions. I found that what worked best for me was to not have expectations of getting a typical night's sleep. I worked off a 24-hour schedule because I could never sleep for more than about 4 hours at a time. I would get up and walk around the house, read, watch TV, snack, etc. and then nap for a couple hours. Instead of trying to impose a schedule on my body, I just did followed my body's cues. I ended up getting a decent night's sleep every 24 hours -- it just wasn't all at once.

It is healthier on this schedule, too, as my spinal nerves were being stretched at least every four hours, if not sooner, from my walking.

It is very important that you get adequate rest. Growing new bone requires a good deal of energy. If you cannot get enough rest, report this to your surgeon.

The Following 3 Users Say Thank You to teteri66 For This Useful Post:
corrine47 (06-05-2012),kathnite1 (06-27-2012),Miasoph (06-05-2012)

Thank you! That is a very good way to think about sleep, how much I'm getting in a 24 hour period, whether it's broken up or not. I remember thinking about sleep that way when my kids were infants and I had broken up sleep. It's been so long I had forgotten.

I called the surgeon yesterday forgetting that he is not in the office on Mondays, so I'll call again today. I had a very good day yesterday. It does seem like I have a couple of good days and then a not so good day. I went to bed last night at 9:30 and have been up since 1:30 walking and sitting at the computer. The pain doesn't seem as intense today.

I live in a two story house, and have been going up and down stairs since the day after surgery. One of the nice things about having a two story house is that I can get up in the middle of the night, come down stairs and turn on the tv without waking anyone else up. I walk a lot off and on during the day.

I only had the L5 S1 done with two cages with cadaver bone inserted. The rest of my back is in great shape. I'm fortunate to have one daughter that just completed nursing school, and another daughter that is in her final year of Physical Therapy school in another city. My son is usually just getting home from his job when I get up with my pain and start pacing. I think I scared him a couple of times with the intensity of the pain, but it's nice to have someone up for part of the time when I'm up.

I happened on this site one night when I was searching for answers/solutions to the leg pains. It's been so very helpful to read what others are or have gone through and what helped them.

I think you can go back into the "My Settings" and change your time zone.

Did your surgeon tell you that you should limit your trips up and down the stairs?
Stair climbing, going up or down a step ladder (later on, of course!) are very hard on you at this point. It puts too much stress on the SI joints, which causes the piriformis muscles to stretch, which can irritate the sciatic nerve or nerves...which can result in leg pain. I just checked when you had surgery...and it was very recently. I would really caution you to limit your trips upstairs to just a couple trips per day....

Also, just by way of explanation why you felt pretty good for the first week or so, then the pain came back. This is a result of what happens at the end of surgery. Right before they close, the surgical site is bathed in steroids and antibiotics. This serves to cut down on the chance of infection and the steroids help keep swelling down and help to get the patient over the worst of the pain. It takes about ten days for the effects of the steroid to wear off.
When this happens, all of a sudden the patient feels more pain, and has a tendency to wonder what is going on, thinking maybe something has "happened."

I think, if you keep your activity to gentle walking, avoid climbing stairs too many times each day, and use ice or a cold gel pack (assuming your surgeon approves) on your lower back/sacral area to keep inflation down, you will find your pain more tolerable.

Just so you are prepared for the weeks ahead, I think you will find that recovery is mostly baby steps, and often, two steps forward, and one back. I found it helpful to stop asking myself "am I better today?" Try to just take it one day at a time. You'll find that when a month has passed, you'll look back and see that you actually have made progress. It just doesn't seem like it at the time while you are going through it.

Please post with any questions, comments or if you're just in need of some support from people who understand what you are going through. Quite a few of us have had fusions and will be happy to try to offer ideas or encouragement.[/LIST]

Thank you so much teteri66. So much of what you say makes so much sense. I guess in my state of mind I'm not thinking clearly. I go see the surgeon tomorrow morning; he's in surgery today. I was hoping I wouldn't need to go in again until my scheduled appointment the end of the month. I guess it's good he wants to check me out. I hope they don't need to x-ray again; i'm going to start glowing in the dark. I have a list of questions and I'll add the stair climbing one to the list. One thing I want to ask him is if it is okay to take ibuprophen or naproxen. I practically lived on it presurgery. I also wanted to ask him about compression stockings. I will ice more frequently which is another thing I practically lived on presurgery. I know that is okay with the surgeon. My husband thinks I need to slow down. He thinks I'm walking too much. I'm definitely going to take it easy today.

Almost all surgeons do not allow their fusion patients to take any form of NSAID post surgery as it can interfere with the growth on the bone cells. Try not to do so much activity that you are tiring yourself. It takes a lot of energy for the new bone cells to form and grow together. The body has a finite amount of energy and the body will take what it needs first to keep the main systems going. So it is important to rest and not let yourself get too tired. You want to give yourself the best chance of having a successful fusion, so in this early time period, make gentle walking and rest your two most important activities. Everything else can afford to wait for a few months.

My surgeon X-rayed me every month for the first seven months. I too was afraid I would be glowing...but I seem to be ok.

The Following User Says Thank You to teteri66 For This Useful Post:
Miasoph (06-05-2012)

I went back to the doctor today. He prescribed Lyrica, one pill at bedtime. He wants me to take it for a week and report back to his nurse the results. Everything else was fine according to him. He doen't want me taking ibuprophen or naproxin. He said that although walking is the best thing to be doing, that I could be overdoing it and to listen to my body. He didn't think the stairs would be causing any problems with the number of times I go up and down them in a day, which is twice on most days. I hope it works!

That sounds about right...give the Lyrica a chance to work...it can take awhile for the body to adjust to it. If both your husband and surgeon think you may be walking too much, I suggest you still walk often. Just shorten each trip. It really is important to give those spinal nerves opportunities to get stretched.

The Following User Says Thank You to teteri66 For This Useful Post:
Miasoph (06-07-2012)

Thank you so much teteri66! It's been very comforting getting on this board and hearing from others who have had similar experiences. I did very well last night. I woke up around 1:00 but was able to move around in bed and go back to sleep until 5:00. I was very groggy and a little dizzy when I got up, so I'm taking it slow. I'm normally a very early riser so this is great. The doctor gave me the okay to get in the bath and pool. I definitely won't do either without someone else being home.

Teteri66, I've read some other threads where you described your surgeries. Are you doing good now?

You might want to start out with pool walking...forward, backward and side- ways, both side-stepping and crossing one leg over the other. You can do various exercises but you probably shouldn't be actually swimming yet. I don't recall when I was allowed to start swimming strokes, but I wasn't allowed to swim on my stomach for almost 10 months, or so. This is because the spine is in extension when swimming on the stomach, unless you are using a snorkle for breathing and keep your spine all on one plane. I got really sick of swimming backstroke!

I just had my two-year check up. No, most surgeons do not follow a patient for such a long time, but I've known my surgeon for 18 years....and he wants to monitor what's going on. I am doing very well, and have finally been given no restrictions...just the old "if it hurts, don't do it." This was my 3rd lumbar surgery, and something finally worked. My pain from stenosis, spondylolisthesis and nerve pain went away on the 4th day, and I've been holding my breath ever since, wondering when it will return! There are some things that I will always have to do in moderation -- my back begins to ache if I bend more than about ten times, so I really have to pace myself when doing physical activities like vacuuming and gardening! But I can walk anywhere now without any pain and stand in lines without feeling like I'm going to pass out from the pain. YIPPEE.

I'm so glad to hear things are going well for you, and hope they continure to go well. On one of my many physical therapy stints I asked the therapist to show me some pool exercises. The ones you described sound like what she showed me. I'll need to dig those papers out. Right now the thought of actually swimming on my stomach scares me. I don't know when I will start physical therapy this time, but will ask for pool exercises. I think your advice about taking one day at a time is the best. Once I got into that mind set I seem to be doing better, expecially mentally. I've always been the caregiver around here. I quit my job as a teacher to take care of my mother in law, granddaughter and then grandson while my daughter went back to school. The grandkids are not 3 and 1. It's hard to switch roles, but I'm coming around. You've been a great help and I thank you again.

You will be able to swim on your stomach, but just not yet. Just like you don't want to arch your spine backward until the fusion of bone is complete, doing the breast stroke or front crawl puts your spine in a similar extended position. If you do just a little bit (once you are cleared to actually swim, as opposed to walking and doing exercises), it won't ruin your fusion. It just puts so much additional stress on the joints, especially when you are kicking your legs, too.

Women have a very difficult time switching gears and letting someone else wait on them, ignoring the dust bunnies as they start to pile up, ignoring the dirty dishes, etc. But try to let go and keep your long-term goal in mind. Right now, a year probably seems like a really long time, but you will be surprised how quickly the time goes by. Just keep reminding yourself you do not want to have to go through this again, so you will do everything in your power to "get it right" the first time. And guess what? The dust bunnies will still be there....For the first year after my last surgery, as far as I was concerned, the only job I had was to work on my rehab. and recovery. Everything else could wait.

Thanks Teteri66! It was three weeks last Thursday and that is still early in the process. Sometimes I wish there was a guide to help with different pains, amount of medication and expectations in general. When I started taking the Lyrica I decided to try just taking one pain pill every six hours. I, like many others on this board, worry about taking too much mediction. I've been experiencing pain in my left buttox and some burning sensations on the left side of where the instrumentation was placed. I'm calling it healing pains. I read everything I could online prior to my surgery but didn't happen upon this board until after the surgery. I also wish more people would have threads about the success they have experienced. You have been so very helpful, and have made me feel like I'm on the right track. Thanks again

I never worried about taking too much pain medication. I took it for eight weeks after my first fusion. I had no problems getting off it. When I realized I didn't need it, I just stopped taking it. I think to some extent it depends on how much the patient is taking prior to surgery. I was not on anything because it didn't help...so there was nothing built up in my system.

Three weeks is very early in your recovery. I was really fairly laid up for those eight weeks, and then I made a lot of progress between the 2nd and 3rd month. At twelve weeks, I felt well enough to fly half way across the country with my son to look for a house for him and his fiancee for five days. I do recall lying on the living room floor in some of the houses while son and the realtor checked out the 2nd floor. I did get tired...but, I was able to do it. By six months I felt pretty much fully recovered. (That was also the point where I decided the surgery had not resolved my nerve pain.)

Just stay positive, keep walking, rest and you'll get there eventually!